not only in theory, but also the practice of general medicine. He should thoroughly understand this complicated organism, the human body, and the complex character of disease. One organ sympathizing with another in intimate relation to the wholethis he had himself advised and always taught. Specialism in the practice of medicine would and must of necessity always exist, but the present overgrowth of specialties he considered a damage to modern medicine. Dr. Leartus Connor remarked that it was impossible in the shortt ime allowed to discuss the numerous topics presented by Dr. Carrow respecting "Injuries to the Eyeball," and by Dr. Frothingham in his report upon "The Progress made during the past year in Ophthalmology, Otology and Laryngology." Concerning Dr. Frothingham's discussion of the specialist in relation to general medicine, he was greatly pleased that it was made before this body of general practitioners. Like all mooted questions, this has two sides. From time to time general practitioners have here presented their side, and now a specialist presents his side. It contains much food for candid reflection and intelligent action. He was glad that it was made in connection with the most complete of all the specialties in medicine, as it has a force otherwise unattainable. There are reasons why all general practitioners should be able to intelligently manage cases of injury to the eye. These injuries occur everywhere, and perhaps more frequently at a distance from any eye specialist. Hence such advice and care as the injured eye gets must come from the general practitioner. At least this must be so for the immediate time. Later, if the injury be severe, a journey may be made to a distant specialist. But often this is too late for any proper recognition of the difficulty, or at least for the preservation of sight. There is also a medico-legal aspect of these injuries. An illustrative case was given showing how legal redress is frequently sought from some real or fancied ignorance and incompetency of the general practitioner in treating these cases. It was also shown that the specialists are constantly protecting the general practitioners from malpractice suits for damages because it was supposed that a blunder had been made. Every person doing much ophthalmic practice has had frequent experiences of this sort. As a rule they protect to the fullest extent their professional brethren by all means at their disposal. It will be admitted that as acknowledged experts in this class of cases their power is large. Hence it is important for the general practitioner, and for his patient, that he be able to recognize the nature of injuries to the eye and adopt wise treatment therefor, whether medical or surgical. Concerning the points made in the two papers nothing need be added now. They are especially adapted for the needs of a body of general practitioners for whom they were prepared. But there is a class of injuries to which attention has not been directed, viz., contusions of the eyeball itself. This accident is relatively infrequent. The mobility of the eye, and the numerous ways by which it is guarded, generally protect it from all blows. But it has fallen to the speaker's lot to see a considerable number of cases in which the eye was less fortunate, being caught between the bony wall of the orbit and the impinging body. In all of these cases the immediate results were alarming. The sight was at once destroyed, the anterior chamber filled with blood, and the iris more or less completely torn from the edge of the pupil to its base. But it has also occurred that in each of these cases ultimate good vision has resulted, the principal crippling of the eyes being due to the rent in the iris restricting its movements, etc. REMARKS ON DR. CARROW'S PAPER. Dr. Noyes remarked that with regard to "Injuries of the Eye," included in Dr. Carrow's paper, and resulting harm to vision, they were so admirably described, and the management of them so judicious and sound, there appeared nothing more to be added. There are, however, a class of wounds and injuries dangerous to vision, not happening directly to the eye itself, difficult to treat successfully, not alluded to in the paper, such as blows and contusions neighboring to the organ of vision. A case of this kind which may be mentioned here, by way of illustration, happened to a base ball player. He was hit by the ball on the cheek-bone, or just below the eye. It gave him little or no trouble at the time, but shortly after it occurred he noticed a progressive failure of sight, which finally resulted in entire loss of vision on that side, undoubtedly due to the severe concussion, reflex irritation of the nerve structures of the eye. Many of the injuries that happen to the eye the general practitioner can, and should, for reasons which Dr. Connor has pertinently pointed out, be able to intelligently manage. But cases requiring the skill of an oculist in the use of instruments, of precision in making out a correct diagnosis, must of necessity be taken to a specialist. Only in this way can the needed treatment be had, and often the general practitioner protected and justice be reached. To illustrate this point, Dr. Noyes said he would cite an interesting medico-legal case which occurred some twenty years ago. A countryman passing along the public highway was hit in the eye by a stray mustard seed shot by a sporting gentleman in the adjoining field. The wound in the sclera of the eye was so small, it appears to have escaped the notice of the physician at the time. A year after it occurred he brought suit for damnages for loss of sight in that eye. As the man had made no complaints for damages at the time of the accident, and as the eye presented no appearance of having sustained injury, it was set up and claimed by the defendant that the case was feigned to extort money. Being summoned in the case at the Sandwich assizes, Canada, after a careful ophthalmoscopic examination of the eye, he was able to state positively that the eye was entirely lost to vision, and gave reasons for that opinion, which proved convincing to court and jury. The interior of the eyeball, the vitreous humor, was observed to be entirely disorganized and packed with a black pigment which entirely intercepted the light from reaching the retina. The jury brought in a verdict for the plaintiff. This case he regarded of special interest, as it also serves to illustrate in a striking manner, the relation of ophthalmic to forensic medicine, and was the first instance, he believed, in this country, of practical ophthalmoscopy in a court of law. |